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Background: The most alarming post-operative consequences for patients and doctors are wound infection and dehiscence. Post-operative wound infection and dehiscence lengthen the hospital stay after surgery. Aims and Objectives: The present study examined the incidence of wound infection, wound dehiscence, duration of hospital stay, and burst abdomen between conventional and Hughes repair techniques of midline laparotomy wound closure. Materials and Methods: A 12-month prospective study was performed in the General Surgery Department at Government Rajaji Hospital in Madurai. In total, 80 patients, divided randomly into two groups of 40 each, received emergency midline laparotomies for various reasons. The primary outcome measures the infection incidence, wound dehiscence, and burst abdomen at the end of 10 days by the assessing surgeon. Results: In the study group, 30 (75%) were males, and females were 10 (25%). In the control group, males were 29 (72.5%), and females were 11 (27.5%). The mean age in the study and control groups was 42.4±11.927 and 41.7±13.607, respectively. There was a significant difference in surgery duration between groups. Most patients, i.e., 27 (67.5%) and 19 (47.5%), had wound infection and dehiscence in the control group, respectively. There was a significant difference in wound infection (P=0.025), wound dehiscence (P=0.002), duration of hospital stay (P

Background: Incisional herniae (IH) are reported in 5–>20 % of patients undergoing open celiotomy, and can be linked to closure technique. The STITCH randomized trial favors a small bite technique for midline celiotomy closure with a 1-year IH rate of 13 % over larger bites (23 %). Methods: A continuous musculofascial mass closure with absorbable looped #1 PDS suture with 2-cm bite size was used for all open celiotomies. IH frequency and associated clinicopathologic factors were retrospectively analyzed from prospective data in 336 consecutive patients undergoing visceral resections by a single surgeon. Results: The study population included 192 men and 144 women, 81 % of whom had a cancer diagnosis, who underwent hepatobiliary, pancreatic, gastroesophageal, and colorectal resections, or a combination. The majority of patients (84 %) had subcostal incisions, and 10 % received a midline incision. At a median follow-up of 19.5 months, the overall IH rate was 3.3 %. Hernia rates were 2.5 % for subcostal margin, 2.9 % for midline, and 5.5 % for other incisions (p = 0.006). Median time to hernia detection was 492 days. Factors associated with IH were increased weight, abdominal depth/girth, male sex, spleen size, visceral fat, and body height (p ≤ 0.04 for all), but not type of resection, prior operations, underlying diagnosis, weight loss, adjuvant chemotherapy or radiation, incision length or suture to incision ratio. Conclusions: The described technique leads to a low IH rate of

Background: The most alarming post-operative consequences for patients and doctors are wound infection and dehiscence. Post-operative wound infection and dehiscence lengthen the hospital stay after surgery. Aims and Objectives: The present study examined the incidence of wound infection, wound dehiscence, duration of hospital stay, and burst abdomen between conventional and Hughes repair techniques of midline laparotomy wound closure. Materials and Methods: A 12-month prospective study was performed in the General Surgery Department at Government Rajaji Hospital in Madurai. In total, 80 patients, divided randomly into two groups of 40 each, received emergency midline laparotomies for various reasons. The primary outcome measures the infection incidence, wound dehiscence, and burst abdomen at the end of 10 days by the assessing surgeon. Results: In the study group, 30 (75%) were males, and females were 10 (25%). In the control group, males were 29 (72.5%), and females were 11 (27.5%). The mean age in the study and control groups was 42.4±11.927 and 41.7±13.607, respectively. There was a significant difference in surgery duration between groups. Most patients, i.e., 27 (67.5%) and 19 (47.5%), had wound infection and dehiscence in the control group, respectively. There was a significant difference in wound infection (P=0.025), wound dehiscence (P=0.002), duration of hospital stay (P<0.001), and burst abdomen (P=0.02) between groups. Conclusion: Hughes repair is associated with less incidence of wound infection, wound dehiscence, burst abdomen, and duration of hospital stay compared to patients whose abdomen was closed using the conventional continuous technique. [ABSTRACT FROM AUTHOR]

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) entails several risk factors for incisional hernia (IH). A few reports available showing incidences between 7% and 17%. At our institution fascia closure has been performed in a 4:1 suture to wound length manner, with a continuous 2-0 polydiaxanone suture (PDS-group) or with a 2-0 polypropylene suture preceded by a reinforced tension line (RTL) suture (RTL-group). Our hypothesis was that these patients might benefit from reinforcing the suture line with a lower IH incidence in this group. The aim was to evaluate the 1-year IH-incidence of the two different closures.Methods: Patients eligible for inclusion were treated with CRS/HIPEC between 2004 and 2019. IH was diagnosed by scrutinizing CT-scans 1 year ±3 months after surgery. Additional data was retrieved from clinical records and a prospective CRS/HIPEC-database.Results: Of 193 patients, 129 were included, 82 in the PDS- and 47 in the RTL-group. RTL-patients were 5 years younger, had less blood loss and more frequent postoperative neutropenia. No difference regarding sex, BMI, recent midline incisions, excision of midline scars, peritoneal cancer index score, complications (≥Clavien-Dindo 3b), or chemotherapy. Ten IH (7.8%) were found, 9 (11%) in the PDS- and 1 (2.1%) in the RTL-group (p = 0.071).Conclusion: An IH incidence of 7.8% in patients undergoing CRS/HIPEC is not higher than after laparotomies in general. The IH incidence in the PDS-group was 11% compared to 2% in the RTL-group. Even though significance was not reached, the difference is clinically relevant, suggesting an advantage with RTL suture.

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used. Methods: A descriptive study was carried out from October 2015 to May 2016. Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds. Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital.

Introduction: Midline laparotomy wound is closed in layers co-opting the various layers separately from historical times; however various methods of closure had come into vogue in the recent years. One such is the single layer mass closure technique, in which all the layers of the abdominal wall are closed in single layer, except for the skin and subcutaneous tissue. Yet another method described is the retention closure technique incorporating all layers including skin and subcutaneous tissue are closed in a single layer. Aim: To compare the postoperative wound complications in layered closure with retention closure technique in midline laparotomy. Materials and Methods: This was a longitudinal cohort study done on 57 consecutive patients who underwent midline laparotomy on an elective or emergency basis over a 12 months period from January 2014 to January 2015 in the Department of General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India. They were divided in to two groups depending on the closure type, layered closure (Group A) and retention closure (Group B) depending on the operating surgeon: retention closure was done in a single surgical unit and layered closure was done in rest of the respective units. Patients were followed up meticulously and immediate postoperative complications were recorded up to four weeks. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, US) software with regression modules installed. Chi-square test and t-test were used to analyse the data. Results: In Group A there was 30 patients while in Group B there were 27 patients. In layered closure technique out 30 patients 12 (40%) patients developed wound infection, 1 (3.3%) patient developed partial dehiscence, and 2 (6.6%) patients developed complete dehiscence. In retention closure technique out of 27 patients only 5 (18.5%) patients developed wound infection, 3 (11%) patients developed partial dehiscence and none of them had complete dehiscence in this group. There was significant association between wound complications and patients with uraemia and hypoalbuminemia. Out of 12 uremic patients 8 (66%) developed wound infection (p-value=0.002), 2 (16.7%) patients developed partial dehiscence and 2 (16.7%) patients developed complete dehiscence (p-value=0.06). In patients who had hypoalbuminemia, out of seven patients, 5 (71.4%) patients had wound infection and 2 (28.6%) patients did not have wound infection (p-value=0.01). Four (57.1%) patients had partial dehiscence and 2 (28.6%) had complete dehiscence only 1 (14.3%) patient did not have any dehiscence (p-value=0.001). Conclusion: Retention closure has some advantages over layered closure in preventing wound infections and burst abdomen. Various risk factors are associated with postoperative wound complications, among which hypoalbuminemia and uraemia have a strong association.

Introduction: Midline laparotomy wound is closed in layers co-opting the various layers separately from historical times; however various methods of closure had come into vogue in the recent years. One such is the single layer mass closure technique, in which all the layers of the abdominal wall are closed in single layer, except for the skin and subcutaneous tissue. Yet another method described is the retention closure technique incorporating all layers including skin and subcutaneous tissue are closed in a single layer. Aim: To compare the postoperative wound complications in layered closure with retention closure technique in midline laparotomy. Materials and Methods: This was a longitudinal cohort study done on 57 consecutive patients who underwent midline laparotomy on an elective or emergency basis over a 12 months period from January 2014 to January 2015 in the Department of General Surgery at Mahatma Gandhi Medical College and Research Institute, Puducherry, India. They were divided in to two groups depending on the closure type, layered closure (Group A) and retention closure (Group B) depending on the operating surgeon: retention closure was done in a single surgical unit and layered closure was done in rest of the respective units. Patients were followed up meticulously and immediate postoperative complications were recorded up to four weeks. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, US) software with regression modules installed. Chi-square test and t-test were used to analyse the data. Results: In Group A there was 30 patients while in Group B there were 27 patients. In layered closure technique out 30 patients 12 (40%) patients developed wound infection, 1 (3.3%) patient developed partial dehiscence, and 2 (6.6%) patients developed complete dehiscence. In retention closure technique out of 27 patients only 5 (18.5%) patients developed wound infection, 3 (11%) patients developed partial dehiscence and none of them had complete dehiscence in this group. There was significant association between wound complications and patients with uraemia and hypoalbuminemia. Out of 12 uremic patients 8 (66%) developed wound infection (p-value=0.002), 2 (16.7%) patients developed partial dehiscence and 2 (16.7%) patients developed complete dehiscence (p-value=0.06). In patients who had hypoalbuminemia, out of 7 patients, 5 (71.4%) patients had wound infection and 2 (28.6%) patients did not have wound infection (p-value=0.01). Four (57.1%) patients had partial dehiscence and 2 (28.6%) had complete dehiscence only 1 (14.3%) patient did not have any dehiscence (p-value=0.001). Conclusion: Retention closure has some advantages over layered closure in preventing wound infections and burst abdomen. Various risk factors are associated with postoperative wound complications, among which hypoalbuminemia and uraemia have a strong association. [ABSTRACT FROM AUTHOR]

Gastroschisis defects are managed with a variety of strategies including primary closure, staged silo reduction with delayed repair, and sutureless closure techniques. In cases of giant gastroschisis defects where primary closure is not feasible, biologic patch coverage has been traditionally considered as a temporary means of closing the abdomen. In this case report we describe two cases of giant gastroschisis defects that were not amenable to primary closure and required temporary coverage with biologic patches. From these cases, we report that biologic patch coverage can serve as definitive management of giant gastroschisis defects without the need for additional surgical management.

The Abdominal Re-Approximation Anchor (ABRA ® ) is a pivotal dynamic wound closure system utilized for achieving primary fascial closure in patients undergoing open abdomen surgeries. However, its efficacy can be hindered in patients with class III obesity due to anatomical complexities and compromised tissue characteristics. Here, we present the unique case of a 25-year-old woman with class III obesity (body mass index (BMI) ≥ 40 kg/m 2 ) who required primary abdominal closure following complications of an ileostomy repair. Traditional placement of the ABRA device was not feasible due to thick subcutaneous tissue layers. Consequently, a modified application of ABRA was decided based on clinical judgment, whereby the ABRA button anchors were strategically placed internally under the subcutaneous tissue instead of externally on the skin surface. The patient completed six intraoperative tightenings of the ABRA device via this novel technique and was treated with washouts over the course of two months until complete resolution was achieved. The presented case demonstrates a successful modification of the ABRA wound closure device to suit an open abdomen patient with class III obesity., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nguyen et al.)

Patients with abdominal aortic aneurysms (AAAs) have a high prevalence of incisional hernia following open repair. The choice of incision and closure technique has a significant impact on this post-operative complication. Multiple techniques exist, as well as various comparative analyses, but clinical consensus is lacking. The objective was to perform a systematic review and meta-analysis of AAA laparotomy and closure technique and the risk of incisional hernia development. The systematic review was performed according to the PRISMA guidelines. A literature search of all original research published until January 2019 was made. Outcome measures were surgical approach, closure technique, hernia rates, length of follow up, and method of hernia recognition. Groups were divided according to method of abdominal incision and closure technique. Differences in outcome between closure techniques were expressed as risk ratios with 95% confidence interval (CI) using a random effects model. Fifteen studies were included with a cumulative cohort of between 388 and 3 399 patients compared in each group. Abdominal closure with a suture to wound length ratio of more than 4:1 compared with less than 4:1, RR 0.42 (95% CI 0.27–0.65), and abdominal closure with mesh compared with without mesh augmentation, RR 0.24 (95% CI 0.10–0.60) reduced the risk of incisional hernia. There were no significant differences in incisional hernia rate between transverse abdominal incision vs. vertical midline incision, RR 0.57 (95% CI 0.31–1.06) and between midline transperitoneal vs. all retroperitoneal incisions, RR 1.19 (95% CI 0.54–2.61). Choice of abdominal closure technique after aneurysm surgery impacts the risk of developing incisional hernia. The use of a supportive mesh significantly reduces the risk of incisional hernia in vertical midline incisions. The same is true if a suture to wound ratio of more than 4:1 is used. [ABSTRACT FROM AUTHOR]

Background: Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The 'Hughes Repair' combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.Methods/design: This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.Discussion: A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.Trial Registration: Trial Registration Number: ISRCTN 25616490 . Registered on 1 January 2012. [ABSTRACT FROM AUTHOR]

INTRODUÇÃO: As perdas de substância da parede abdominal são substituídas por próteses sintéticas. Acontecem vantagens e desvantagens. O omento maior é uma estrutura totipotente e se aplica, também, à reparação. OBJETIVO: Apresentar possibilidade técnica de fechamento de parede abdominal com omento após ressecção da parte muscular. MÉTODO: Operou-se dois pacientes adultos com adenocarcinoma de colo direito invadindo a parede abdominal. Foi necessária a ressecção da metade direita da parede para fazer parte do monobloco. A metade esquerda do omento maior, remanescente, foi usada para vedar a cavidade abdominal através de sua sutura às bordas da ferida. Pôde-se recobrir com pele mobilizada nos flancos. A evolução foi satisfatória. No pós-operatório tardio formou-se hérnia incisional. CONCLUSÃO: O omento maior é um recurso a mais para reparar a perda parcial de parede abdominal.INTRODUCTION: The loss of substance of the abdominal wall is usually replaced by synthetic prostheses with advantages and disadvantages. The greater omentum is a totipotent structure and can be applied also to this repair. OBJECTIVE: To present technical possibility of abdominal closure after resection of abdominal wall muscle part with omentum. METHOD: The technic was carried out in two adult patients with colonic adenocarcinoma with invasion of the right abdominal wall. Was required the resection of the right half of the abdominal wall to join the en-bloc resection. The left half of the greater omentum was used to seal the abdominal cavity fixing it with sutures to the edges of the surgical wound. Final closure was done with the skin freed from the flanks. The recovery was satisfactory. In the late postoperative period incisional hernia occurred. CONCLUSION: The greater omentum can be used to repair the partial loss of the abdominal wall.

Gastroschisis defects are managed with a variety of strategies including primary closure, staged silo reduction with delayed repair, and sutureless closure techniques. In cases of giant gastroschisis defects where primary closure is not feasible, biologic patch coverage has been traditionally considered as a temporary means of closing the abdomen. In this case report we describe two cases of giant gastroschisis defects that were not amenable to primary closure and required temporary coverage with biologic patches. From these cases, we report that biologic patch coverage can serve as definitive management of giant gastroschisis defects without the need for additional surgical management. [ABSTRACT FROM AUTHOR]

Abstract: The open abdomen is a common condition after a trauma necessitating celiotomy with the inability to close the fascia either due to damage control surgery or abdominal compartment syndrome. Traditionally the open abdomen has been approached with the use of the open abdomen temporary abdominal closure (Barker Vacuum Pack Dressing). More recently there has been the addition of the ABThera™ open abdomen negative pressure unit introduced by KCI. Our case report is based on the first patient to have placement of the ABThera™ device. [ABSTRACT FROM AUTHOR]